Autogenous bone grafting in clinical osteomyelitis and septic nonunion (the papineau technique)

The technique of extensive wound debridement and secondary use of autogenous cancellous bone chips can be used to salvage both septic nonunions and chronic osteomyelitis. The same technique may also be used to bridge large bony defects of traumatic origin. With time, the cancellous bone becomes completely incorporated and strengthens, allowing full use of the limb. There are few complications with the procedure. Nonunion may develop on occasion and require a closed bone graft once the wound is free of infection and closed. The major surgical principles are: 1) adequate debridement with removal of all infected tissue, 2) a viable base to support the graft, 3) the use of autogenous cancellous bone, 4) adequate immobilization, and 5) delayed wound closure.1-5.